Provider Demographics
NPI:1396510442
Name:CARTER, CHARMELLE JANA (BA, CPSS, QP)
Entity type:Individual
Prefix:
First Name:CHARMELLE
Middle Name:JANA
Last Name:CARTER
Suffix:
Gender:F
Credentials:BA, CPSS, QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 IVY HTS
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-3815
Mailing Address - Country:US
Mailing Address - Phone:336-937-6135
Mailing Address - Fax:
Practice Address - Street 1:1411 IVY HTS
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-3815
Practice Address - Country:US
Practice Address - Phone:336-937-6135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health